In
accepting your request to comment on the medical and psychological
situation of Mr. Augusto Pinochet Ugarte on the basis of
the tests conducted in the Military Hospital of Chile, January
10-13, 2001, as well as a brief hospitalization after that
date and subsequent appraisal of the patients state
of health suggesting that the fingerprinting ordered by
the court could negatively affect him, I present the following
report.

My
professional merit for offering my comments is based on
my dual functions as neurologist and psychiatrist, for which
I earned my professional degrees both in Chile and Canada,
where I am a specialist in the treatment and research of
dementia. As you know, I am a member of the "International
Working Group", which evaluates procedures in the research
of dementia in various countries upon request from the World
Health Organization and the World Neurology Federation.

First:

Unlike
what occurred in London with the same patient, during the
three and a half days of tests the patient was subjected
to standard medical-neurological tests and a series of physical,
neurological, and mental examinations, as well as a battery
of intense neuro-psychological tests. On that occasion the
subject exhibited an interest, willingness, a cooperative
spirit and physical strength beyond what I expected of a
patient who had been described as suffering "severe
diabetes, hypertension and afflicted by serious disturbances,
from a severe diabetic neuropathy."

However,
the most significant aspect of my examination was having
detected a high degree of analytic capacity of situations
unknown to him, in addition to a power to associate facts
with the distant past, in the course of the tests conducted
by eight examiners. His responses were exceptionally good
and quite adequate for the occasion. By way of example and
without committing a breach of confidentiality all patients
deserve, it is important to recall his appropriate and incisive
remarks related to the situation of the tests.

His
remarks made reference to my participation as expert, as
proposed by the plaintiffs, my family, and my origins in
Iquique and references to the current mayor of that port
city, who he called "Choro Soria".

In
these statements, the patient showed judgment, reasoning
and the ability to employ different forms of memory, quickly,
and with great efficiency to establish temporary associations
related to place, as well as mechanisms of long-term biographic
memory.

Considering
that this exercise was conducted with a person he did not
know, and only by association with my fairly uncommon last
name was able to make such a complex association on the
first day of the tests, when we met for the first time in
our lives. Undoubtedly, the patients cognitive functions
were operating well. This initial impression was confirmed
on the second day of tests. When he entered the room assisted
by a cane and with great self-confidence, he commented this
time on my resemblance to Spanish sociologist Joan Garces,
who was advisor to President Salvador Allende and maintains
good ties of friendship with Judge Garzon in Spain. On this
occasion I asked him to explain what he meant by my supposed
resemblance to Garces. He replied that the resemblance is
not only physical  which might have been the case
 but also, he explained very abstractly and aptly
that the resemblance is in "belonging to the accusing
party." Furthermore, in an important demonstration
of handling attention span and projection in time, he added:
"...and you as neurologist and psychiatrist, may
contact me later if you need further explanation."

This
exercise undoubtedly confirmed the efficiency of various
types of memory, beyond the testing situation, and executive
type abilities of judgment and very adequate memory. It
is my view that these are practically normal for an 85-year-old
male with his level of education.

Second:

All
the results of the tests conducted during those days exhibited
a vascular, subcortex dementia, as the lesions from millimetric
strokes are located in areas under the brain cortex, therefore
affecting activities related to movement, while not affecting
superior brain functions such as memory, reasoning, judgment,
etc.

The
assessment of the patient suggests that the severity of
the situation corresponds to a "slight dementia."
However, due to the location of the micro-strokes, it would
be more accurate to classify it as "slight to moderate."

As
you know, this diagnosis was verbally accepted by all the
examiners in Santiago on the date the tests were conducted,
as certified by the document signed by the Judge and Court
Secretary. It is curious that, as you also know, the final
report prepared in Chile by the Director of the Medical
Legal Service, Dr. America Gonzales and sent to me for my
signature, changed the final conclusion to "moderate
severity."

As
was publicly known, not only did I disagree with that change
in degree of severity  "they made the patient
worse in less than two days." From a professional standpoint
I believe they committed a serious technical error in discounting
the report of the patients caregiver who was in daily
contact with him for more than 10 days and was fully aware
of his activities each day. This person indicated that the
patients functions were very well intact. As an example,
the caregivers report notes that the patient was perfectly
capable of choosing the clothes to put on each day, could
handle money, credit cards, his bank account, remember birthdays
and give appropriate gifts to his grandchildren, among other
activities.

I
should note that the Medical Legal Service experts
lack of familiarity with assessment procedures and universally
accepted criteria used in diagnosis of dementia frankly
surprised me. My astonishment increases in light of the
fact that such criteria are widely used every day by Chilean
academics. Evidence of this fact was the work presented
by groups that study dementia at the Universities of Concepcion
and Valparaiso at the most recent symposium on dementia
organized by the University of Toronto last March.

On
the other hand, in the discussion we had in January, those
professionals argued that "there is only one kind of
dementia", and that "there is only one memory
and dementia can destroy it" and "if memory is
lost, all types of memory are lost." These are
concepts that were clarified by science at least twenty
years ago, and are no longer employed by academics, not
even historically. What is most serious is that the professionals
failed to accept the opinion that the patients affliction,
if adequately and medically controlled, can be and should
be arrested.

Third:

In
this particular case, medical conditions such as hypertension,
diabetes, pacemaker, etc., are risk factors, especially
as this is a geriatric patient.

However,
all such conditions are controlled every day by any moderately
equipped medical center, research and integration of various
kinds of specialists in the geriatric field today. This
is exceptionally important in vascular dementia, as these
fall among the few cases of reversible dementia that
may be corrected.

In
other words, it does not have the progressive and irreversible
characteristics common to neuro-degenerative conditions
such as Alzheimer.

Regarding
the patients emergency hospitalization in the Military
Hospital last January 26, reports made known officially
by the Hospital itself which should have presented the opinions
of the doctors who treated the patient, reveal an interpretation
that departs from reality or significantly ignores the pathology
experienced by the patient.

One
example is observed in the section that states the patient
suffered "a severe headache", "a light
and passing loss of consciousness", "a
slight loss of strength on his left side." The
next sentence suggests a "possible pre brain crisis
isquemica transitory and possible pre brain stroke."
I do not wish to enter into technical detail at this moment.
But having maintained a patient of this age, with the medical
infirmities he has, less than 24 hours under observation
in a Hospital, knowing his history of subcortex strokes,
and with the suspicion that he could suffer another transitory
crisis, appears to be bad medical practice.

However,
the information presented, and particularly the severe headaches
and slight loss of conscious, suggests to me that these
are not symptoms characteristic of a transitory crisis.
Moreover, it is not clear how they were able to assess a
sudden slight loss of strength in the patients left
side. Two weeks earlier, when I examined him in the same
hospital, he already had a marked weakness  nearly
paralysis on that same left side  due to a subcortex
lacunar stroke that everyone who examined him noted in the
brain scan conducted January 11, in the Las Condes Clinic
Radiology Department.

Fifth:

In
direct response to one of your questions and taking into
consideration all these factors, I draw the following conclusion
from a medical point of view, in light of intellectual,
cognitive and mental conditions, particularly the good spirits
and physical conditions exhibited by the patient. This patient
can be questioned by Judge Juan Guzman without risk to his
health condition. The procedure would not place at risk
his diabetes, hypertension, or transitory brain crisis if
proper medical precautions are taken. Such precautions should
not constitute any kind of obstacle in the patients
daily life.

Suggestions
that "trauma and psychic stress" or "oxilant
deterioration" or that even taking his photograph
or fingerprints might "affect psycho-physical conditions
of the patient" are not compatible with current
practice of metabolic and cognitive disturbances of the
elderly.

Lastly,
the statement recently made public suggesting that the late
inception diabetes that affects the patient could alter
mental and cognitive capacities is arbitrary and hardly
scientific. It seems to me almost irresponsible that someone
should suggest it, considering that the days we examined
Mr. Pinochet the diabetes was under control despite long
and tedious tests for hours and hours at a time.

Hoping
to have answered your concerns, most sincerely,

Dr.
Luis Fornazzari MD FRCPC.

Clinical
Director of Neuropsychiatry
Department of Neurology and Psychiatry
University of Toronto Mental Health Center